Provider Demographics
NPI:1588762363
Name:JOHNSON, DEBORAH M (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735A UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4406
Mailing Address - Country:US
Mailing Address - Phone:415-271-6524
Mailing Address - Fax:415-345-1923
Practice Address - Street 1:1735A UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4406
Practice Address - Country:US
Practice Address - Phone:415-271-6524
Practice Address - Fax:415-345-1923
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL183620Medicare ID - Type Unspecified